SIU Field Investigator I,II, or Sr.

Location

Bakersfield, CA | United States

Job description

JOB SUMMARY
This job is responsible for investigating and analyzing complex, multi-discipline coverage and claims that have been referred to the special investigation unit
(SIU) for potential fraud. This role typically handles a combination of complex attorney represented and unrepresented claims and moderate to complex losses,
in which suspicious activity has been identified. The individual performs a thorough investigation including; (1) conducting background searches, scene
investigations, and clinic inspections; (2) taking recorded statements; (3) reviewing and analyzing medical notes, bills, and property damage; and (4) conducting
witness interviews and social media searches. The individual conducts surveillance on property and/or creates scene reconstructions on some investigations and
reviews whether fraud can be substantiated and supports a lawsuit. The individual provides work guidance and direction to less senior employees and provides
mentoring and coaching to the team.
KEY RESPONSIBILITIES

• Researches and responds to complex customer communications, concerns, conflicts or issues
• Summarizes documents and enters into claim system notes, documenting a claim file with notes, evaluations and decision-making process
• Utilizes analytic tools or SIU field intelligence to identify complex claims for investigation and/or for support in the evidence of the fraud and damages
• Conducts thorough investigations of complex that are potentially fraudulent to determine if payment is warranted, including scene investigations and
• surveillance as needed
• Validates that the information provided and obtained through investigation is true and accurate and follows up on all possible leads
• Conducts complex online data application searches, research, and evaluation
• Conducts complex site inspections, including body shops, medical clinics, loss locations etc.
• Reviews investigations with fraud outcomes to validate whether denial is appropriate
• Updates files with investigation outcome, and when no fraud or insufficient evidence is found, returns file to MCO for further handling and settlement
• Enters SIU claim data information into multiple SIU systems

SUPERVISORY RESPONSIBILITIES

• This job does not have supervisory duties.

EDUCATION AND EXPERIENCE

• 4 year Bachelors Degree (Preferred)
• 2 or more years of experience (Preferred)
• In lieu of the above education requirements, an equivalent combination of education and experience may be considered.

CERTIFICATIONS, LICENSES, REGISTRATIONS

• .No Certification, License or Registration is required for the job.

FUNCTIONAL SKILLS

• Applies broad knowledge of insurance policy, coverage, and regulation
• Applies broad knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
• Applies broad knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
• Applies broad knowledge of problem solving and preparation of reports for analysis
• Applies broad negotiation and/or arbitration skills
• Ability to investigate, evaluate, negotiate and settle complex claims
• Applies broad knowledge of training facilitation and coaching skills

#LI-MP1

National General prides itself on offering our employees a robust Total Rewards package which includes base salary. The base range offered for the role is: $57,500 - $92,000 and may vary based on internal equity, and job-related skills, knowledge and experience; among other factors. Other financial components may be added as part of the competitive compensation package, in addition to a full range of benefits, dependent on the level and position offered.

National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.

Job tags

Salary